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Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs.
This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty.
Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18–65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million.
There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.
Psychosocial and health-related risk factors for depressive symptoms are known. It is unclear if these are associated with depressive symptom patterns over time. We identified trajectories of depressive symptoms and their risk factors among midlife women followed over 15 years.
Participants were 3300 multiracial/ethnic women enrolled in a multisite longitudinal menopause and aging study, Study of Women's Health Across the Nation. Biological, psychosocial, and depressive symptom data were collected approximately annually. Group-based trajectory modeling identified women with similar longitudinal patterns of depressive symptoms. Trajectory groups were compared on time-invariant and varying characteristics using multivariable multinomial analyses and pairwise comparisons.
Five symptom trajectories were compared (50% very low; 29% low; 5% increasing; 11% decreasing; 5% high). Relative to whites, blacks were less likely to be in the increasing trajectory and more likely to be in the decreasing symptom trajectory and Hispanics were more likely to have a high symptom trajectory than an increasing trajectory. Psychosocial/health factors varied between groups. A rise in sleep problems was associated with higher odds of having an increasing trajectory and a rise in social support was associated with lower odds. Women with low role functioning for 50% or more visits had three times the odds of being in the increasing symptom group.
Changes in psychosocial and health characteristics were related to changing depressive symptom trajectories. Health care providers need to evaluate women's sleep quality, social support, life events, and role functioning repeatedly during midlife to monitor changes in these and depressive symptoms.
Many women experience both vasomotor menopausal symptoms (VMS) and depressed mood at midlife, but little is known regarding the prospective bi-directional relationships between VMS and depressed mood and the role of sleep difficulties in both directions.
A pooled analysis was conducted using data from 21 312 women (median: 50 years, interquartile range 49−51) in eight studies from the InterLACE consortium. The degree of VMS, sleep difficulties, and depressed mood was self-reported and categorised as never, rarely, sometimes, and often (if reporting frequency) or never, mild, moderate, and severe (if reporting severity). Multivariable logistic regression models were used to examine the bi-directional associations adjusted for within-study correlation.
At baseline, the prevalence of VMS (40%, range 13–62%) and depressed mood (26%, 8–41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Over 3 years of follow-up, women with often/severe VMS at baseline were more likely to have subsequent depressed mood compared with those without VMS (odds ratios (OR) 1.56, 1.27–1.92). Women with often/severe depressed mood at baseline were also more likely to have subsequent VMS than those without depressed mood (OR 1.89, 1.47–2.44). With further adjustment for the degree of sleep difficulties at baseline, the OR of having a subsequent depressed mood associated with often/severe VMS was attenuated and no longer significant (OR 1.13, 0.90–1.40). Conversely, often/severe depressed mood remained significantly associated with subsequent VMS (OR 1.80, 1.38–2.34).
Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.
The interannual variations in atmospheric transport patterns to Summit, Greenland, are studied using twice-daily, three-dimensional, 10 day backward trajectory data corresponding to the summers (1 June–31 August) of 1989–98. While previous trajectory climatology studies have been prepared for Summit, the present work considers both the horizontal and vertical components of transport. A three-dimensional residence-time methodology is employed to account for both horizontal and vertical components of transport. the vertical transport component is quantified by passing all trajectories through a three-dimensional grid and tracking the time spent (i.e. the residence time) in each gridcell. This method also allows inspection of trajectory altitude distributions corresponding to transport from upwind regions of interest. the three-dimensional residence-time methodology is shown to be a valuable tool for diagnosing the details of long-range atmospheric transport to remote locations. for Summit, we find that the frequent transport from North America tends to occur at low altitudes, whereas transport from Europe is highly variable. Mean summertime flow patterns are described, as are anomalous patterns during 1990,1996 and 1998.
Clinical trials in psychiatry inherit methods for design and statistical analysis from evidence-based medicine. However, trials in other clinical disciplines benefit from a more specific relationship between instruments that measure disease state (e.g. biomarkers, clinical signs), the underlying pathology and diagnosis such that primary outcomes can be readily defined. Trials in psychiatry use diagnosis (i.e. a categorical label for a syndrome) as a proxy for the underlying disorder, and outcomes are defined, for example, as a percentage change in a univariate total score on some clinical instrument. We label this approach to defining outcomes weak aggregation of disease state. Univariate measures are necessary, because statistical methodology is both tractable and well-developed for scalar outcomes, but we show that weak aggregate approaches do not capture disease state sufficiently, potentially leading to loss of information about response to intervention. We demonstrate how multivariate disease state can be captured using geometric concepts of spaces defined over routine clinical instruments, and show how clinically meaningful disease states (e.g. representing different profiles of symptoms, recovery or remission) can be defined as prototypes (geometric locations) in these spaces. Then, we show how to derive univariate (scalar) measures, which capture patient's relationships to these prototypes and argue these represent strong aggregates of disease state that may be a better basis for outcome measures. We demonstrate our proposal using a large publically available dataset. We conclude by discussing the impact of strong aggregates for analyses in traditional and novel trial designs.
We have obtained a K band image of the central 30 × 40 arcminutes of the Galaxy at a scale of 1.4″/pixel using a 256 × 256 Pt: Si Schottky barrier diode array detector provided by the Hughes Aircraft Company. The excellent cosmetic quality and large field of this device provide an unprecedented view of the inner Galaxy. Images of the central 10 arcminutes at a scale of 0.9″/pixel in the H (1.65μm) and K (2.2μm) bands produced with the same detector array have been combined to produce a color picture, which clearly shows the circumnuclear molecular ring in absorption; this picture demonstrates directly that the southwestern side of the ring lies in front of, and the northeastern side behind, the Galactic center.
The development and spread of glyphosate-resistant (GR) horseweed has increased the use of dicamba as an alternative herbicide treatment. Research evaluated suspected glyphosate-resistant horseweed populations from DeKalb (GR-1) and Cherokee (GR-2) counties, Alabama, for response to glyphosate, dicamba, and glyphosate + dicamba. Populations used for resistance determination were tested at rosette and bolt growth stages. Glyphosate resistance evaluation treatments ranged from 0 to 36.0 kg ae ha−1. Data confirmed that GR-1 and GR-2 horseweed populations were 3.0 to 38 times more resistant to glyphosate than the susceptible population, according to population, data type, and growth stage at treatment. GR-1 and GR-2 populations were further evaluated for response to dicamba. Dicamba was applied at 0 to 1.12 kg ai ha−1, both with and without the addition of glyphosate at 1.12 kg ae ha−1. All populations had similar tolerance to dicamba, with the exception of GR-2 treated at the rosette growth stage, which had ~2-fold greater tolerance. When glyphosate was tank-mixed with dicamba, the response of GR populations was similar to that of dicamba alone. Therefore, any potential resistance-management benefit of tank-mixing dicamba with glyphosate may be negated when one is attempting to control GR horseweed. Conversely, adding glyphosate to dicamba drastically enhanced control of the susceptible population at both growth stages.
Impaired neuropsychological functioning is a feature of major depression. Previous studies have suggested that at least some aspects of neuropsychological functioning improve with successful treatment of major depression. The extent to which medications may affect the degree of normalization of these functions is unclear. The aim of the current study was to examine the course of neuropsychological functioning during treatment of major depression with cognitive–behaviour therapy (CBT) or schema therapy (ST).
A total of 69 out-patients with a primary diagnosis of major depression and 58 healthy controls completed mood ratings, neuropsychological measures, and measures of emotional processing at baseline and after 16 weeks. Participants were randomized after baseline assessment to a year-long course of CBT or ST. Patients reassessed at 16 weeks were medication-free throughout the study.
Significant neuropsychological impairment was evident at baseline in depressed participants compared with healthy controls. After 16 weeks of psychotherapy, mean depression rating scores fell more than 50%. However, no neuropsychological measures showed convincing evidence of significant improvement and emotional processing did not change.
Persisting impairment in neuropsychological functioning after the first 16 weeks of CBT or ST suggests a need to modify psychological treatments to include components targeting cognitive functioning.
The fossil record of solemydid turtles is primarily based on isolated fragments collected from Late Jurassic to Late Cretaceous sediments throughout North America and Europe and little is therefore known about the morphology and evolutionary history of the group. We here provide a detailed description of the only known near-complete solemydid skeleton, which was collected from the Lower Cretaceous (Aptian–Albian) Antlers Formation of Texas during the mid-twentieth century, but essentially remains undescribed to date. Though comparison is limited, the skeleton is referred to Naomichelys speciosa, which is based on an isolated entoplastron from the Lower Cretaceous (Aptian–Albian) Kootenai (Cloverly) Formation of Montana. The absence of temporal emarginations, contribution of the jugals to the orbits, and a clear subdivision of the middle and inner cavities, and the presence of elongate postorbitals, posteriorly expanded squamosals, a triangular fossa at the posterior margin of the squamosals, an additional pair of tubercula basioccipitale that is formed by the pterygoids, foramina pro ramo nervi vidiani (VII) that are visible in ventral view, shell sculpturing consisting of high tubercles, a large entoplastron with entoplastral scute, V-shaped anterior peripherals, and limb osteoderms with tubercular sculpture diagnose Naomichelys speciosa as a representative of Solemydidae. The full visibility of the parabasisphenoid complex in ventral view, the presence of an expanded symphyseal shelf, and the unusual ventromedial folding of the coronoid process are the primary characteristics that distinguish Naomichelys speciosa from the near-coeval European taxon Helochelydra nopcsai.
The Preceramic archaeological record of highland Mesoamerica is biased toward rockshelter sites. We advocate more fieldwork in streamside settings, where open-air sites are likely to be found for reasons related both to the systemic context of hunter-gatherer lifeways and to the geoarchaeological context of site burial and preservation. Predicting site location requires attention to the peculiar nature and behavior of incised ephemeral streams (barrancas) and to the complex alluvial stratigraphic sequences that they leave behind. Four case studies—from the Mexican states ofTlaxcala, México, Morelos, and Oaxaca—reconstruct the geometry and age structure of late Quaternary alluvium from exposures in cutbanks, brickyards, and purposefully dug trenches. We identify deeply buried locales with the remains of extinct megafauna, intentionally set fires, and lithic debitage. We distinguish between geographical areas, stream reaches, and time intervals that do or do not hold much promise for further research. The fragmentary nature of the alluvial record and the paucity of sites can be explained by changes in stream behavior wrought by agricultural land use and are conditioned by the intensity and antiquity of agriculture in any given area. Deposits and sites of Paleoindian age may be more commonly preserved than those of Archaic age.
People with psychoses often report fixed, delusional beliefs that are sustained even in the presence of unequivocal contrary evidence. Such delusional beliefs are the result of integrating new and old evidence inappropriately in forming a cognitive model. We propose and test a cognitive model of belief formation using experimental data from an interactive ‘Rock Paper Scissors’ (RPS) game.
Participants (33 controls and 27 people with schizophrenia) played a competitive, time-pressured interactive two-player game (RPS). Participants' behavior was modeled by a generative computational model using leaky integrator and temporal difference methods. This model describes how new and old evidence is integrated to form a playing strategy to beat the opponent and to provide a mechanism for reporting confidence in one's playing strategy to win against the opponent.
People with schizophrenia fail to appropriately model their opponent's play despite consistent (rather than random) patterns that can be exploited in the simulated opponent's play. This is manifest as a failure to weigh existing evidence appropriately against new evidence. Furthermore, participants with schizophrenia show a ‘jumping to conclusions’ (JTC) bias, reporting successful discovery of a winning strategy with insufficient evidence.
The model presented suggests two tentative mechanisms in delusional belief formation: (i) one for modeling patterns in other's behavior, where people with schizophrenia fail to use old evidence appropriately, and (ii) a metacognitive mechanism for ‘confidence’ in such beliefs, where people with schizophrenia overweight recent reward history in deciding on the value of beliefs about the opponent.
Polymeric materials are widely used in power generation and energy storage applications. Deoxyribonucleic acid (DNA) biopolymer-based hybrids have been found to display interesting electrical characteristics, such as a relatively high dielectric constant, good resistivity and dielectric breakdown behavior, and are promising as insulating dielectrics for capacitor applications. This research describes the processing, test structure design, and electrical characterization of DNA-sol-gel hybrids for energy storage applications.
The electronic structure of delta plutonium (δ-Pu) and plutonium compounds is investigated using photoelectron spectroscopy (PES). Results for δ-Pu show a small component of the valence electronic structure which might reasonably be associated with a 5f6 configuration. PES results for PuTe are used as an indication for the 5f6 configuration due to the presence of atomic multiplet structure. Temperature dependent PES data on δ-Pu indicate a narrow peak centered 20 meV below the Fermi energy and 100 meV wide. The first PES data for PuCoIn5 indicate a 5f electronic structure more localized than the 5fs in the closely related PuCoGa5. There is support from the PES data for a description of Pu materials with an electronic configuration of 5f5 with some admixture of 5f6 as well as a localized/delocalized 5f5 description.
Many metallic actinide systems host partially filled 5f electrons in the low-energy spectrum. Consequently, they exhibit diverse quantum mechanical phenomena such as magnetism, superconductivity, a mysterious hidden-order phase, or heavy-fermion behavior. Here we present results of a unified theoretical method based on the self-consistent GW formalism for the electronic many-body self-energy. We calculate the dynamic electronic correlation spectra starting from materials specific first-principles electronic band-structure. In particular, we present results for four isostructural intermetallic actinides PuCoIn5, PuCoGa5, PuRhGa5, and UCoGa5. A common underlying property of these materials is a strong spin–orbit coupling split band structure that enables substantial spin fluctuations. In a feedback effect on the electronic structure they create electronic ‘hot spots’, where the single-particle spectral weight is maximum, resulting in a universal peak-dip-hump feature. These results are in good agreement with experiments, suggesting that actinides are adequately described by the intermediate Coulomb interaction regime, where both itinerant (peak) and localized (hump) features coexist.
Both surgical and percutaneous closures of atrial septal defects have been successful in reversal of atrial dilatation. We compared the effects of surgical and percutaneous transvenous device closure of atrial septal defect on post-operative changes of P-wave duration, PR segment, and PR interval. Electrocardiographic data were prospectively collected from 30 patients following either surgical (n equal to 16) or percutaneous (n equal to 16) repair of atrial septal defects between 2004 and 2010. A cardiologist blinded to the closure technique performed the electrocardiographic analyses. P-wave duration (98.5 plus or minus 15.4 to 86.4 plus or minus 13.2 milliseconds, p-value less than 0.05) and PR interval (162.9 plus or minus 18.5 to 140.6 plus or minus 15.2 milliseconds, p-value less than 0.05) were reduced after percutaneous transvenous device closure. P-wave duration (104.5 plus or minus 24.7 versus 83.2 plus or minus 13.3 milliseconds, p-value less than 0.05) and PR interval (173.2 plus or minus 38.7 versus 144.3 plus or minus 32.0 milliseconds, p-value less than 0.05) were also reduced after surgical closure. PR segment in the percutaneous group was significantly reduced (63.4 plus or minus 14.5 to 52.1 plus or minus 10.8 milliseconds, p-value less than 0.05), but not in the surgical group (68.6 plus or minus 18.7 versus 61.1 plus or minus 24.7 milliseconds). However, the difference in PR segment changes between the two groups was not significant (−11.3 plus or minus 15.0 versus −7.6 plus or minus 20.5 milliseconds, p-value equal to 0.18). Our analysis demonstrates that the changes between the two groups were not different and that both closure techniques reduce P-wave duration, PR segment, and PR interval within 6 months.